Introduction Small bowel ulcers are frequently reported on capsule endoscopy (CE) and double balloon enteroscopy (DBE). The aetiology is not always clear. Histology is useful in addition to clinical symptoms and blood parameters to aid diagnosis and further management. Enteroscopy allows both direct visualisation of the mucosa and histological sampling. The aim of this study was to evaluate the impact of DBE on management of patients with small bowel ulcers.
Method A retrospective review of DBE’s performed for suspected Crohn’s disease from 2006–2014 was carried out. Data was collected for demographics, clinical symptoms and blood parameters. Findings at DBE, histology and subsequent follow up were noted.
Results In our series of 399 DBEs, 122 procedures were performed in 102 patients (male = 44; female = 58; mean age 46 (range 18–84)) for suspected Crohn’s disease (53 oral; 69 retrograde). Ninety percent (n = 92/102) of patients had a prior CE. Ten patients were unable to have CE due to a retained patency capsule or contraindications, however had abnormal radiology preceding DBE. Positive DBE findings were found in 56% of patients (n = 57; ulcers n = 47; stricture n = 8; abnormal mucosa n = 2). Forty percent of patients (n = 41/102) were eventually treated for Crohn’s disease. In 22 patients the histology was diagnostic (n = 7) or supportive (n = 15) for Crohn’s disease.
Fifty-eight percent of patients with small bowel ulceration had non-diagnostic histology (normal n = 22; non-specific changes n = 11). Of the 33 patients with non-diagnostic histology, 58% (n = 19) were subsequently treated for presumed Crohn’s disease based on clinical symptoms, blood parameters and macroscopic findings on endoscopic investigations. Thirteen patients who were treated as Crohn’s disease had immunosuppressive therapy (azathioprine +/- anti-TNF or methotrexate). Eleven patients were empirically treated with steroids only and two patients were referred for surgery. The mean follow period for patients in the Yorkshire region was 29 months (range 1–104 months). The remainder of patients were treated for vasculitis (n = 1), latent TB (n = 1), functional symptoms (n = 4) and nsaid enteropathy (n = 3) in whom NSAIDs were discontinued. In 15% of patients no specific cause was found. Two patients were found to have carcinoid (n = 1) and follicular lymphoma (n = 1) on histology.
Conclusion DBE has a useful place in clarifying the diagnosis in about half of patients with small bowel ulcers. Although histology can be non-diagnostic, the combination of the macroscopic appearance with clinical correlation is helpful in the diagnosis and management. Longer term follow up data would be useful.
Disclosure of interest None Declared.